Swine flu: Is Modi-led government doing too little too late?

Even as the health departments reiterate their stand repeatedly by claiming that ‘everything is under control’, the H1N1 swine flu virus continues to spread rapidly across the country. As we write this, more than 22,000 people from different parts of the country have been tested positive with this virus, with over 400 of them losing their lives.

The situation on the ground

Rajasthan, Gujarat and Delhi are the worst hit states, with Gujarat imposing section 144 in Ahmedabad to stop mass gathering in order to check swine flu. While a number of people have been proactive in buying masks and wearing them at public places, the fact remains that most of these masks aren’t equipped to prevent the virus from entering your respiratory system. The pore size of many such masks is bigger than the virus itself, making them ineffective. While the clinically certified masks are also available in the market, they cost 20 times more than the normal masks. Also, unless these masks are disposed carefully after use, the threat of the virus doesn’t fade away.

Patients from a number of cities have also reported trouble in getting tamiflu medicine, the only proven cure of swine flu. According to the hospitals, many people are buying tamiflu without getting themselves tested, which is resulting into a shortage of drug. Since its symptoms are similar to normal seasonal flu, people have started taking the medicine as a ‘precautionary measure’ without consulting a doctor.

One of the other reasons leading to shortage of tamiflu is that it is a Schedule X drug, which is sold by a very few drug stores. A Schedule X drug can only be sold if the buyer presents a prescription from a qualified doctor. Additionally, the retailer is required to keep a copy of the prescription for the next couple of years after sale of the drug.

Experts say that a rise in temperature would bring down the number of cases since the virus thrives in cold climate.

What is the Government up to?

The Government, on its part, has begun procurement of 60,000 units of tamiflu medicine along with 10,000 N-95 masks (clinically certified for protection from swine flu virus). About 10,000 diagnostic kits are also in the process of being procured by the Government to ensure that there is no shortage of logistics.

In Delhi, the Government has fixed the fees of diagnostic tests at Rs 4,500. The labs flouting these norms are being given show cause notice by the Government. Although Delhi has seen the largest number of confirmed swine flu cases this year, the death rate in the city is much lower comparatively, owing to much better medical facilities as compared to other parts of the country.

A doctor draws blood from a man to check for HIV/AIDS at a mobile testing unit in Ndeeba, a suburb in Uganda's capital, Kampala. VOA

A new study of a popular HIV drug could ease concerns about its link to depression. Researchers in Uganda found that efavirenz, once feared to lead to depression and suicide, did not cause the expected negative side effects in their patients.

Efavirenz is an affordable, once-a-day pill used around the globe to treat and prevent HIV/AIDS. It’s “the treatment of choice” in most of the world, according to Africa Health Research Institute’s Mark Siedner, “especially [in] countries that depend on global aid to treat HIV.”

But some fear that efavirenz may come with a cost.

Some studies in the United States and Europe found the drug increased patients’ risk of depression or suicide, although other studies did not.

The mixed results prompted many doctors in the United States to prescribe more expensive but potentially safer drugs.

Siedner wanted to take another look at the risk of depression, this time in an African population. From 2005 until 2015, he and a team of Ugandan and U.S. doctors tracked 694 patients who took either efavirenz or another antiretroviral medication. They regularly asked the patients whether they experienced depression or suicidal thoughts.

No difference

Their analysis, published in the Annals of Internal Medicine, showed there was no difference between the two treatments. Siedner told VOA, “In other words, efavirenz was not associated with a risk of depression. If anything, there seems to be a signal that potentially it was associated with a decreased risk. But it wasn’t a strong enough [signal] for us to say that.”

The authors also reported that of the 17 participants who died in the course of the study, not a single death was a suicide.

Siedner has two possible explanations for why their findings differed from those in Western countries. “One potential cause is that every single ethnic group in the world, of course, is different, and different in many different ways — different socially, different environmentally, and in this case they may be different genetically.” His team is looking at whether the genes that control metabolism of the drug have a role to play in this story.

HIV virus is Not Linked To Depression. Flickr

A second explanation could be the effectiveness of the drug. Because efavirenz is so potent, it could be keeping people healthier than they expected, so patients are less likely to report negative emotions.

The study is important, said Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, because it pushes back against “the initial observation of suicidal ideation and suicide and depression” as caused by efavirenz. He told VOA, “I think now what you’re seeing is that with these conflicting reports, it’s likely someone will come in [with] the proposal to do a randomized study and take a look. So the story isn’t ended with this paper.”

As more research on the safety of efavirenz is conducted, new and cheaper drugs that might replace it are on the horizon. One of them, dolutegravir, might also pose a risk, however. A study in Botswana found dolutegravir was linked to neural tube defects in embryos, meaning it might not be safe for pregnant women. As always, further research is needed to confirm whether this is a common problem or specific to the population studied in Botswana.